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FOR OFFICE USE APPLICATION FOR SANITATION PERMIT .......... - - - - - 'Complete inTriplicate) Permit No. This Permit Ex ires,l Year From Date Issued-y: -3- 73 P r.y � � Date Issued ,1.._..- r .B.F Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County /�Ordinance No. 5499 d existing Rules and Regulations: JOB ADDRESS/LOCATION j:--.-/ i:iJy/.�...---- _'------- > .. {.: .�_t'v..._.,.:. S-r'...------CENSUS TRACT ----------------------- Owner's Name ------ t`-"�'L.'-'�-----.-j- �ti...---------------_---------------•- ---�--fi�=---.,_..�Phone 1 CL_ mac_ sL/ Address -- -- ' -- -- ------------------- -------------- ---_. City ----- Contractor's --- y` 1�• t l -lh z' <L_.�f J`f' --�.t mkx'__License # ..��'4'YciN_Z_ Phone Contractor's Name -_. ..-. Installation will serve: Residence Apartment House❑ Commercial []Trailer Court ;❑ Motel ❑ Other --------------------...................... Number of living units:... Number of bedrooms,-7---_---Garbage Grinder --------- Lot Size _-_-._----. Water Supply: Public System and name ----------------------------------------------...--__............................_......................Private ❑ Character of soil to a depth of 3 feet: Sand E] Silt❑ Clay p Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe LN Fill Material ------------ If yes,type .--._._-.--_.--:._---_-._- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ J SEPTIC TANK[ I Size--------__.........;..__..-.--__._------- Liquid Depth __ __-....-_______ Capacity .------------------- Type -------------- ----- Material----- --- _---- ---- No. Compartments Distance to nearest: Well ------------ ------_.____..----Foundation ------------ Prop. Line ----__--_---------6 LEACHING LINE No. of Lines -_._(.-----------__ Length of each lineTotal Length ...le_e---------__-- // ` / D' Box __/__ Type Filler Material -_._ .-...__Depth Filtter Material --.-.. 1_f---------------------�_-- � Distance to nearest: Well --- -. Foundation ----- Property Line -._.T ------- SEEPAGE PIT [ Depth .._.: -- Diameter ----- f-_�y Number _/------------- Rock Filled Yes No ❑,�j Water Table Depth --------------_-.rZ--- ---------------Rock Size __.._ -.�._........- __16 p Distance to nearest: Well __ _ <.- _-.--__Foundation ./ .1..- - Pro Line _ C -1-._V{ REPAIR/ DDITIONJPrev. Sanitation Permit# ----_-_-_.__.-_ - Date -__�_..--._.-._---__- _. C Septic Tank (Specify Requirements) __- � l . . -, -.ck �.__ c_ J C. F Disposal Field (Specify Requirements) ------------r!4---- . _ -<�,- -----.J a.J____ r ..... ....-.� - - .. _.._ .- - - ------------------------ ------------------- -------- --- - ---------- --- ------------- - - / --......------.............._...._..-------_.. _. ....-............. ---------- ----------------------- - - ----- IDrow existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ................._...-..---------......----------------- --- - ---------..-----. Owner _ .._ i / C — By - �,..l,'.------' f t2:C: l[,c.....-------------------... Title ...._�2�. '<',c��.�-�C;-._<` :t....... ........... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . -_-- - -- .- .._-_... -,r_.Fy_--...... ._ _..... DATE BUILDING. PERMIT ISSUED --- - . ..-- - -- - ----- -- - - _. DATE ---------------------------------------- ADDITIONAL COMMENTS -------- ------------------------------ - - -- - ----- -- -- -------------------------..._.... - ------------------------------------ - - --------------------------------------- - ---- - ---- ----- ------ -------- -- - ---- -- p,� - r-7 .. . yyy ..O -- Final Inspection by: _ Date � SA JOAQUIN LOCAL 'HEALTH DIFRICT